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If you are a woman with bipolar disorder, you may experience a double whammy during a profound time in your life — menopause.

Bipolar Disorder and Menopause: The Estrogen Effect

“Unfortunately, menopause can exacerbate bipolar disorder,” says Ahsan Y. Khan, MD, professor in the department of psychiatry and behavioral sciences at the University of Kansas School of Medicine-Wichita and director of Via Christi Psychiatric Outpatient Clinic, also in Wichita. “You can be irritable and dysphoric [anxious] at the same time. And then here come hormones into play. They compound the problem.”

Although doctors don’t completely understand the complex biochemistry behind the reaction, clinical research consistently suggests that a significant number of women with bipolar disorder are more sensitive to hormonal shifts during menopause and the powerful changes going on in the body. At menopause in particular, they report more depressive episodes than women without bipolar disorder, at least partly because of a normal menopausal decrease in the powerful hormone estrogen.

The connection between estrogen and mood disorder is not completely clear. What researchers do know is:

High levels of estrogen tend to have a “brightening effect” on mood, while low levels promote a dampening of mood.

Estrogen will decrease during menopause and the five- to 10-year period before menopause, known as perimenopause.

A drop in estrogen can have particular consequences for the bipolar patient, doubling susceptibility to depressive episodes.

Bipolar Disorder and Menopause: Not Everyone Gets an Increase in Symptoms

Does this mean all women with bipolar disorder will experience a return of depression and complications of mood as estrogen levels decrease during menopause? Not necessarily.

While psychiatrists consistently field an increase in depressive reports during their bipolar patients’ menopausal years, research suggests that a high percentage of, but not all, women experience an escalation of depressive symptoms during menopause.

By the time you’re in your mid-30s, your doctor should begin checking your hormone levels to make sure menopausal hormone fluctuations are not overlooked as a contributing factor to your mood issues.

“If there is a worsening of symptoms without any other change in life, I would ask my patient if they are going through menopause,” says Dr. Khan. “I would ask them to contact their primary care doctor to look at hormone levels.”

Khan recalls the case of a 51-year-old bipolar patient who was being unsuccessfully treated for a sudden increase in mood symptoms. It wasn’t until her doctors measured her hormone levels that they realized she was in menopause. As soon as she started on hormone replacement, her symptoms dramatically decreased, says Khan.

Bipolar Disorder and Menopause: Options for Treatment

If your doctor finds a hormonal imbalance, he or she may suggest one or both of these options:

Hormone replacement therapy (HRT). If your symptoms don’t improve after adjusting the dosage of or otherwise make changes in your current regimen of bipolar medications, HRT might be beneficial. However, HRT must be considered carefully because it increases the risk of heart disease, stroke, and blood clots. Some women are advised against HRT because of existing health conditions that may be worsened by it.

Talk therapy. Speaking with a qualified therapist may help. Some women may need or want to talk about pessimistic thoughts, about their life, and about the fact that they can no longer bear children, says Khan.

Sometimes the problem gets worse with treatment before it gets better. Synthetic estrogen, for example, has been known to increase stimulation and anxiety in some women — exactly what you don’t want. A lower dose or another hormone combination might work better. This may take time and patience to discover.

Indeed, just as there is no one way to combat bipolar disorder and just as it takes time to find the right combination of medications, so it is for managing your menopausal symptoms. Your care team is there to help.

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